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Barrett's esophagus
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Barrett's esophagus

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DIGESTIVE SYSTEM
Cancer

Treatment

Barrett's esophagus is a complication of long term acid reflux disease. Barrett's esophagus is, the link between Barrett's esophagus and acid reflux disease, and the link to esophageal cancer.

Common heartburn isn't always just an annoying condition that's quickly remedied by an over-the-counter antacid. It can also be symptomatic of gastroesophageal reflux disease (GERD), which is the chronic regurgitation of acid from your stomach into your lower esophagus. And, long-term GERD can sometimes lead to Barrett's esophagus, a condition in which the color and composition of the cells lining your lower esophagus change because of repeated exposure to stomach acid. Having Barrett's esophagus increases your risk of developing esophageal cancer.

Barrett's esophagus usually develops from gastroesophageal reflux disease (GERD). Heartburn and acid reflux are the most common symptoms of GERD and result from stomach contents washing into the esophagus.

The ring of muscle at the junction of the esophagus and stomach (sphincter) normally traps acid in your stomach by clamping shut. GERD usually results from a weakened sphincter, and it can be aggravated by a protrusion of the upper stomach, where the esophagus passes through the diaphragm (hiatal hernia).

Left untreated, GERD can lead to more serious complications such as severe heartburn (with esophagitis) — the chest pain can be intense enough to resemble a heart attack — stricture, bleeding, Barrett's esophagus and even esophageal cancer.

It's not too late to treat Barrett's esophagus if you don't have advanced cancer. However, many people with esophageal cancer show up so late in the progress of the disease that doctors first discover Barrett's esophagus at the same time they find the cancer.

Treatment for Barrett's esophagus may start with controlling GERD by making a number of lifestyle changes and taking self-care steps. These actions include getting more exercise, losing weight, avoiding foods that aggravate heartburn, stopping smoking if you smoke, taking antacids or stronger acid blocking medications, and elevating the head of your bed to prevent reflux during sleep.

People with severe GERD and Barrett's esophagus usually need aggressive treatment, which may include medications, other nonsurgical medical procedures or even surgery.

Medications

Proton pump inhibitors (PPIs) such as omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix) and esomeprazole (Nexium) are drugs that block production of acid and relieve irritated tissue.

Doctors sometimes prescribe another class of drugs called H-2-receptor blockers to treat GERD and Barrett's esophagus. They're weaker than PPIs, although less expensive. Prescription H-2-receptor blockers such as famotidine (Pepcid, Mylanta AR), cimetidine (Tagamet), nizatidine (Axid) and ranitidine (Zantac) are available over the counter in doses less than prescription strength.

Although these medications often are quite effective for GERD, once Barrett's metaplasia is present these drugs won't reliably reverse the condition, and the risk of cancer remains.

Surgery

Anti-reflux surgery (laparoscopic Nissen fundoplication) offers an alternative to dependence on medication for GERD and Barrett's esophagus. The procedure tightens the sphincter by wrapping part of the stomach around the lower esophagus to prevent acid reflux. Laparoscopic surgery involves inserting special instruments through small incisions — less than an inch. The procedure leaves only tiny scars. You can expect to stay in the hospital for one or two days following this surgery.

Although surgery can be effective for GERD, once Barrett's metaplasia is present surgery won't reliably reverse the condition, and the risk of cancer remains.

If you have esophageal cancer, or if you have Barrett's esophagus and high-grade dysplasia, your doctor may recommend you undergo a procedure in which the esophagus is removed completely and the stomach is pulled into the chest (esophagectomy). After this surgery, you may lose up to 20 pounds, spend 10 to 12 days in the hospital and require up to six weeks to recover.

The surgical treatment of people with high-grade dysplasia is controversial. Some experts believe that esophagectomy should be used as a measure to protect against cancer. Other experts believe that surveillance through endoscopies at three- to six-month intervals and esophagectomy — if cancer develops — are sufficient. Doctors generally don't recommend surgery for people with declining health or for those who are too weak to withstand a major procedure.

Alternatives to medications and surgery

Removal (ablation) of dysplasia makes possible the reversal of Barrett's esophagus, and it may prevent esophageal cancer. Combined with PPIs, ablation may be appropriate especially if you're not a good candidate for an esophagectomy. Ablation procedures include:

  • Photodynamic therapy. First, you'll take a drug to make the Barrett's cells sensitive to light. Then, your doctor inserts a light into your esophagus. Tissues that the light touches are burned off. The Food and Drug Administration has approved the photosensitizing agent Photofrin to treat Barrett's esophagus.

  • Electrocautery. Your doctor inserts an electric wire into your esophagus to burn away dysplasia.

  • Laser therapy. Your doctor uses a hot beam of light (laser) inserted into your esophagus to burn away Barrett's cells. This procedure is effective but difficult to apply evenly.

  • Argon plasma coagulation. Your doctor releases a jet of argon gas into your esophagus along with an electric current to burn away dysplasia.

The long-term effectiveness of ablation procedures in preventing cancer is not known.

 

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
In no event will The DrEddyClinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.

 


 



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Last Modified : 03/14/08 07:03 PM